Pathology of Hypertension Flashcards
Hyaline Ateriolosclerosis
- Associated with what disease?
- Cause?
- Patient Profile?
- Appearance?
Disease Association:
• Benign Hypertension
Cause:
- Pressure pushes plasma proteins across injured endothelial cells
- Chronic Stress ^ increases matrix synthesis
Patient Profile:
• Hypertensive patients or Old people
Appearance:
• Thick Intima with very pink appearance from deposited proteins
Hyperplastic Arteriolosclerosis
- Associated with what disease?
- Cause?
- Appearance?
Disease Association:
• SEVERE (malignant) Hypertension
Cause:
- Increased strain causes Muscle cells to become thickened and duplicated
- FIBRINOID NECROSIS may also occur
Appearance:
- Onion Skinning appearance
- Amphoric and pink in the case of fibrinoid necrosis
Thrombosis
• cause of thrombosis in Vascular Disease?
Formation of a Blood Clot from Exposed ECM
• in this context Exposed ECM comes from ruptured plaque
Embolus
• cause?
Thrombus is mobilized and can move throughout vasculature
Atherolsclerosis
- Disease characterized by Intimal Lesions called artheromas
- these artheromas have a lipid core surrounded by a fibrous cap
Medial Calcific Sclerosis
- Common in people over 50 y/o where Calcium is seen in the intima
- Don’t freak out if you see this on a radiograph or mammogram as long as it follows a vessel its okay
What is the significance of: Turbulence, Dyslipidemia
• Two most common causes of endothelial injury leading to atherosclerosis
What is a Fatty Streak?
i
What is a Plaque?
i
What is Stenosis?
Occlusion of an artery caused by large atherosclerotic plaque
Aneurysm
Ballooning out of all 3 layers of a vessel due to weakening of the media
Dissection
i
T or F: Hypertension puts you at an increased risk for renal failure?
True, this risk is especially high in people with diabetes and hypertension
What are the cutoffs for hypertension?
140 mmHg systolic 90 mmHg diastolic
In what case might you place a patient with a blood pressure of lower than 140/90 on anti-hypertensive medication?
• High risk patients such as those with Diabetes may need treatment earlier than other people
T or F: in the case of hypertension preventative medicine has proven to be extremely effective.
True
What causes most cases of hypertension?
90% of cases are idopathic
What are some diseases that often have a secondary effect of hypertension?
• Renal Disease
• Renal Artery Narrowing
• Adrenal Disorders
Why is hypertension often a secondary result of many renal disorders?
- Macula Densa falsely Sense Low Blood Volume because of renal disease
- Increased Renin –> angiotensin I –> angiotensin II will lead to increased fluid volume and a heart that is beating harder
- Aldosterone may be secreted in too large amount in adrenal tumors etc. (pheochromocytoma)
How do you calculate Cardiac Output?
CO = Heart Rate x Stroke Volume
What is the standard response of the vascular wall to injury?
- Smooth Muscle Hyperplasia in INTIMA
- ECM is synthesized
- PERMANENT intimal thickening result
Atherosclerosis
- Cause
- Vessels involved
- Disease Type
Cause:
• LIPID Accumulation with Cellular Reaction
Vessels Involved:
• Large and Medium Arteries
Disease Type:
• Considered an INFLAMMATORY DISEASE
What are the most common arteries to see atherosclerosis in?
• Abdominal Aorta
• Coronary Arteries
• Cerebral
• Common Iliac
• Femoral Arteries
****What is this?
• Clinical Significance
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/396/445/q_image_thumb.png?1460098896)
Monckebergs
• Typically not clinically significant
**Monckebergs
- Cause
- Vessel type
- Appearance (radiology and H&E)
- Significance
Cause:
• Cacification of Vessel Media
Vessel:
• Muscular Arteries
Appearance:
- Dark purple calcium deposits in the media on H and E
- Follows the path of the vessel on Radiology
What patient population is Monckenbergs often seen in ?
• Ppl. 50 years and older commonly have Monckebergs
**Arteriolosclerosis
- Cause
- Vessel type
- Types
Cause:
• Reduced lumen size from thickening of vessel in response to high pressure
Vessel Type:
• Small Arteries
2 types:
• Hyaline
• Hyperplastic
What diseases are associated with arteriolosclerosis?
- Diabetes
- Hypertension
****What is this?
• key features?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/401/657/q_image_thumb.png?1460098923)
Nephrosclerosis
• Pitting Scars on the surface that should be smooth
****What is this?
• Patients this is most commonly seen in?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/401/658/q_image_thumb.png?1460098944)
Onion Skinning in Hyperplastic Arteriolosclerosis
• Most commonly seen in patients with malignant hypertension (>200mmHg systolic)
*****What is this?
• Patients this is most commonly seen in?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/401/659/q_image_thumb.png?1460098955)
Hylaine arteriolosclerosis - intimal thickening from ECM expansion
• seen in Elderly and people with Benign Hypertension
*****What is this?
• Patients this is most commonly seen in?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/401/660/q_image_thumb.png?1460098977)
Hyperplastic arteriolosclerosis that has caused Fibrinoid Necrosis of Small Renal Arteries